Yet another nationwide fraud sweep
Latest takedown meant to spotlight Obama efforts
Asweep of 107 arrests for Medicare fraud scams in seven cities marked the fourth time the Obama administration had corralled an array of unrelated healthcare cases for a national announcement.
The purpose of such takedowns, this one orchestrated May 2, is to demonstrate that fighting healthcare fraud is a priority for the administration and to deter more people from participating in such activity, according to current and former federal anti-fraud officials.
“When President Obama took office, he asked the attorney general and me to make fraud prevention a Cabinet-level priority,” HHS Secretary Kathleen Sebelius said at a news conference announcing the latest busts.
Those marching orders led HHS and the U.S. Justice Department to grow a combined Medicare fraud-fighting team started in March 2007 in the southern district of Florida by the Bush administration to nine cities across the nation.
The strike forces have spearheaded an increased emphasis on criminal prosecution of healthcare fraudsters, producing since their launch more than 1,330 arrests of people allegedly involved in trying to bilk more than $4 billion from the program. The presidential
orders also led to the use of high-profile group arrests of large numbers of defendants, coordinated to occur nearly simultaneously for maximum publicity.
The large coordinated arrests in disparate locations across the country—last week’s was the second-largest number of defendants to date and the largest dollar amount with $452 million in alleged false claims—is a tactic borrowed from previous federal efforts seeking to both encourage and respond to public calls for action, such as the “war on drugs,” according to former federal anti-fraud officials.
The approach garners greater media coverage than individual arrests and smaller dollar amounts, but it is not without risks. It inevitably means some local law enforcement agents have to wait weeks or months to arrest a suspect if the arrest is required to occur with other cases where officials are close but not yet ready to make an arrest, the former officials said.
Medicare fraud suspects have fled in the past before their arrests, said Gabriel Imperato, a defense attorney for Broad and Cassel in Fort Lauderdale and a former deputy counsel for HHS in Dallas. However, suspects also have fled after their arrest and release on bond, he said.
The strategy also carries a risk for providers, according to some former federal officials, because the busts may increase the likelihood that people with little evidence against them will be swept up in an effort to boost overall numbers.
Even before the advent of large group arrests for healthcare fraud, federal anti-fraud officials have arrested or searched the offices of healthcare providers without ultimately bringing charges, said Jack Fernandez, a defense attorney for Washington-based Zuck- erman Spaeder and a former assistant U.S. attorney. But charges that are eventually dropped and even the execution of search warrants without any later arrests can professionally destroy a physician.
“If you think a physician has done something wrong, there are ways to find that information out without having to arrest that person,” Fernandez said.
The administration has been under pressure from some members of Congress to make more such arrests. For instance, Sen. Tom Coburn (R-okla.), who is a physician, urged a panel of federal anti-fraud officials testifying before the Senate Finance Commit- tee on April 24 to arrest and obtain lengthy sentences for physicians as a deterrent.
“If the doctors that are signing false certifications for home health aren’t going to jail, you’re not sending the signal for other doctors to change their behavior,” Coburn said. His call is fueled by a growing belief that fraud on that scale perpetrated against Medicare and Medicaid is only possible with the involvement of many physicians, who are the gatekeepers, according to one former federal prosecutor.
As in previous group arrest announcements, federal officials noted last week that the charges were leveled at physicians, as well as other types of healthcare professionals. Three physicians were specifically mentioned, although neither HHS nor Justice officials provided a total number of them included in last week’s arrests.
The Medicare strike force’s first prosecution of physicians involved a 2008 crackdown on costly HIV infusion therapy fraud in South Florida, which led the criminals behind the schemes to admit to prosecutors that they were having more difficulty recruiting new physician partners, said Paul Pelletier, a defense attorney at Mintz Levin and a former principal deputy chief for litigation at the Justice Department. Medicare billing for the service in three South Florida counties dropped from 72% of all Medicare payments for such services in 2006 to a demographically proportionate amount after the crackdown, according to HHS’ inspector general’s office.
“We weren’t indicting every single infusion therapy provider, but we were doing a coordinated takedown so that they knew that we were on to them,” Pelletier said.